Reducing Daytime Sedation While Preserving Motor Function in Parkinson’s Disease Psychosis: A Case Report of Psychotropic Timing and Deprescribing

Psychosis and behavioral dysregulation in advanced Parkinson’s disease (PD) are commonly managed with psychotropic medications that may worsen motor symptoms or contribute to excessive daytime sedation. We describe a 77-year-old male with advanced PD and psychosis admitted following agitation-related self-removal of a percutaneous endoscopic gastrostomy (PEG) tube. Collateral history revealed persistent morning somnolence that limited participation in physical therapy and daily care activities. His medication regimen included multiple agents with sedating properties, raising concern for cumulative pharmacologic burden contributing to impaired daytime function. A structured approach to medication adjustments was implemented, focusing on selective deprescribing, consolidating sedating medications to evening dosing, and simplifying the overall regimen. Following iterative medication adjustments, agitation improved without escalation of standing psychotropic medications. Morning alertness improved, with increased participation in therapy sessions, while motor function remained stable. This case highlights an individualized approach to balancing behavioral control, daytime alertness, and motor preservation in PD psychosis while illustrating how cumulative sedative burden and medication timing may influence functional outcomes.